The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

Effect of Helicobacter pylori Eradication on the Development of Reflux Esophagitis and Gastroesophageal Reflux Symptoms: A Nationwide Multi-Center Prospective Study

BACKGROUND/AIMS: A two-year, prospective, nationwide multicenter study was undertaken to evaluate the effect of Helicobacter pylori eradication on the development of reflux esophagitis (RE) and gastroesophageal reflux disease (GERD) symptoms in the Korean population. METHODS: In total, 1,489 subjects without RE were enrolled at the outpatient clinics of 12 tertiary hospitals nationwide, and 452 subjects underwent follow-up (F/U) for 2 years to evaluate the development of RE and GERD symptoms. RESULTS: RE was found in 33 subjects (7.3% of 452 subjects) and 14 subjects (7.3% of 192 subjects) during the first and second year of F/U, respectively. H. pylori status was not associated with the development of RE. RE was found in six (9.0%) of 67 H. pylori-negative patients, in 26 (11.2%) of 233 eradicated subjects and in eight (7.0%) of 114 noneradicated subjects (p=0.532). Multivariate analysis showed that age > or =60 years (odds ratio [OR], 7.11; 95% confidence interval [CI], 1.92 to 26.41), alcohol consumption (OR, 4.43; 95% CI, 1.03 to 19.19) and F/U cholesterol levels > or =200 mg/dL (OR, 5.03; 95% CI, 1.32 to 19.17) were significant risk factors for the development of RE. There was no significant difference in the development of GERD symptoms or weight according to H. pylori status during the 2-year F/U. CONCLUSIONS: Eradication of H. pylori did not affect the development of reflux esophagitis or GERD symptoms among patients in outpatient gastroenterology clinics in South Korea.

A case of gastric granulocytic sarcoma in a patient with transformed acute leukemia from myelodysplastic syndrome / 대한내과학회지

Granulocytic sarcoma is a localized tumor that's composed of immature cells of the granulocytic series. The tumor may be involved anywhere in the body, but we present here a rare case that involved the gastrointestinal tract (and especially the stomach). Granulocytic sarcoma may represent the initial manifestation of blast transformation or it may herald the onset of acute leukemia from myelodysplastic syndrome. We report here on a case of gastric granulocytic sarcoma in a patient with transformed acute leukemia from myelodysplastic syndrome. A 56-year-old male who was suffering with myelodysplastic syndrome (RARS) for 5 years presented with upper abdominal pain. Gastrofiberoscopy revealed an elevated lesion with central erosion at the posterior wall of the gastric upper body, which histologically proved to be a granulocytic sarcoma. The peripheral blood smear and bone marrow examination showed acute myeloid leukemia.

Esophageal Ulcer by Thermal Injury from Steamed Egg / 대한소화기내시경학회지

The common causes of esophageal ulcers include severe reflux esophagitis, carcinomas, pill-induced esophagitis, viral diseases, caustic injury, foreign bodies and radiation injury. In rare cases, they can also be caused by Crohn's disease, Behcet's disease, syphilis and idiopathic causes. A thermal injury caused by the ingestion of hot food has not been reported to be a cause of esophageal ulcers. We report an alcoholic who developed an esophageal ulcer and odynophagia after ingesting part of an extremely hot steamed egg with a review of the few available reports regarding such injuries. We suggest that the ingestion of extremely hot food should also be considered a cause of esophageal ulcers.

A Case of Ectopic Sebaceous Glands in the Esophagus / 대한소화기내시경학회지

Ectopic sebaceous glands have been reported in the organs of an ectodermal origin such as the oral cavity, genitals, eye and orbit, nipples, palm and soles, and the parotid glands. Their presence in the esophagus, which is an organ of endodermal origin, is a very rare and interesting anomaly. Whether ectopic sebaceous glands in the esophagus are the result of congenital misplacement or acquired metaplastic change remains unclear. We report here on a patient with sebaceous glands in the esophagus, and this was diagnosed by endoscopic biopsy.

Endoscopic Removal of Foreign Bodies in the Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: Foreign bodies in the upper gastrointestinal tract are produced chiefly by accidental swallowing, but rarely produce symptoms. Although most foreign bodies pass spontaneously, 10~20% of those need treatment. We evaluated the role of endoscopy for removal of foreign bodies in the upper gastrointestinal tract. METHODS: We retrospectively reviewed 80 cases of foreign bodies in the upper gastrointestinal tract who had been treated using endoscopy at Konyang University Hospital from February 2000 to July 2003. RESULTS: The age ranged from 14 months to 75 years (mean 36.8 years-old). Patients over 60 years, under 10 years were 20 cases and 28 cases, respectively and male to female ratio was 1.1:1. Common foreign bodies are coin (20 cases), fishbone (12 cases), animal bone (11 cases) and meat stuff (9 cases). The most common location was the esophagus (68.8%). In most cases (88.8%), foreign bodies were removed using alligator tooth forceps. Fourteen patients had co-morbidities such as esophageal diseases, psychiatric disorders, diabetes mellitus, hypertension, stomach cancer, and subtotal gastrectomy. CONCLUSIONS: Endoscopy is a useful tool for removal of foreign bodies in the upper gastrointestinal tract.